Mobile Imaging Company Provides Services to Rural Nursing Homes in Texas—Thanks to a Scion and Starbucks
To Improve Cambodian Health Care, Telemedicine Program Goes Where Roads Cannot
New Conference Focuses On Information Capture

Mobile Imaging Company Provides Services to Rural Nursing Homes in Texas—Thanks to a Scion and Starbucks

Advanced Imaging Services Inc (AIS), a San Antonio-based imaging company, is bringing new meaning to the phrase “mobile x-ray”—with a little help from Starbucks and a fleet of more-than-fully loaded Scions. No, the company is not promoting the double espresso; AIS’ radiologic technologists (RTs) quickly transmit digital images using wireless portals like those offered for free or via paid monthly pass at Starbucks, FedEx Kinko’s, and even a Dairy Queen or two.

And that is only the last step in a 21st-century workflow designed to minimize the time between physically scanning a patient and receiving a report back from a radiologist. The AIS system, which was designed by Dicom Solutions Inc, Aliso Viejo, Calif, optimizes efficiency by using the latest imaging technology coupled with today’s free Internet services—from the wireless hotspots that are popping up around the country to free navigational tools like Google Earth.

AIS President Phil Rathbun started his mobile imaging business in 1993. “The old way that it was done,” he said, “was the x-ray tech would go into the nursing home, shoot x-rays with film, and then fight the traffic all the way back to the office. The images would all be processed, then they’d be scanned digitally and sent off from there.”

A fully loaded Scion xB features all of the latest technology necessary to quickly perform mobile imaging, including a Kodak Orex CR and a Candelis ImageGrid IG700 server.

His system today is a little different. Yes, the RT still drives to the site, which is generally a nursing home in rural Texas. However, the vehicle is a Scion xB that is equipped with a DC-to-AC inverter and loaded with a mobile CR system from Kodak Orex, an accompanying laptop, an ImageGrid IG700 server from Candelis, and a GPS navigator.

“We offer heart echocardiograms, ultrasound, bone-density testing, and x-ray,” Rathbun said, explaining how AIS eventually edged out competing mobile x-ray services: “As our business changed, we were able to move rapidly from rural hospitals—which eventually will get their own ultrasound machine and technicians and everything—into the nursing facilities.”

After scanning the patient on site, the RT loads the images onto the laptop in the Scion and drives to the nearest wireless hotspot. From there, data is transmitted from the server to a radiologist via a virtual private network that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

“We just move to the local Starbucks, where we have an [Internet] account, and we send right there from the café while we’re having a latte,” Rathbun said. He laughed and added, “Everybody in Starbucks is probably thinking, ‘Man, the Internet is getting kind of slow all of a sudden,’ as we’re blowing these 20-megabyte x-rays through the system.”

Before, Rathbun emphasized, his RTs spent the bulk of their time fighting traffic as they moved from company headquarters to sites in rural areas and back.

Chad Hutchison of Dicom Solutions, who installed Rathbun’s system, said, “The amazing part of this whole story is the time. One, they have a GPS tracking system to know where their vans are at all times. Two, they call ahead so the patient is ready. And three, they transmit these images back as fast as they can, and the images are sent immediately to a radiologist in Florida to be read so the report comes back in a timely manner.”

Rathbun estimated that the new workflow has made his turnaround time on images 75% faster. He also noted that it saves his business money. “Now, I don’t have as many chemicals, I don’t have as much in my processing rooms, we don’t use as much gas, and I don’t have as much film,” he said. “Even though the up-front costs were high, the technology has paid for itself.”

—C. Vasko

To Improve Cambodian Health Care, Telemedicine Program Goes Where Roads Cannot

A telemedicine initiative called Operation Village Health is bringing health care to Cambodia. The program, developed and maintained by Partners Telemedicine, Boston, allows volunteer physicians in the United States to communicate with Cambodian health workers—even in villages so remote they do not have running water or electricity. Bringing radiologists on board, however, has been difficult.

The technology infrastructure for Operation Village Health was established by American Assistance for Cambodia, a donor-funded, nongovernmental group. Partners Telemedicine—which was founded by Massachusetts General Hospital and Brigham & Women’s Hospital and is affiliated with Harvard Medical School—works with Ratanakiri Referral Hospital in Ban Lung and nurses at the Rovieng Health Center.

Health workers in Cambodia triage consultations and then send cases to US physicians via e-mail—in Rovieng’s case, by booting up a computer via generator, as the village has no electricity. Joseph Kvedar, MD, leader of the program and vice chair of dermatology at Harvard Medical School, explained, “A network of primary care doctors are waiting for e-mails. We get it all done by close of business that day. They’re [waking up] when they receive our reply e-mails, and that’s when they will prescribe or administer therapeutics.” More than 600 patient visits have been completed through Operation Village Health since 2001.

The system does not just improve village health care; it also educates isolated health workers in Cambodia on an ongoing basis, enabling them to learn from some of the best physicians in the country. “We’ve introduced a number of point-of-care tests there, for them to do things like blood glucose and a variety of lab tests and urine tests,” Kvedar said.

Remote outposts in Cambodia communicate with physicians in the United States via e-mail through the Operation Village Health program.

Operation Village Health recently was awarded top honors at the Stockholm Challenge, a global initiative to recognize the impact of information technology on communities across the world. The Challenge’s jury noted, “Medical services often do not reach the people who most need them. Intermediaries, red tape, education difficulties, and poverty create barriers.”

At Ratanakiri—which is accessible only via air, as the road leading there has been washed out for years—ultrasound and x-ray are available. Images are printed on film, photographed using a digital camera, and sent to physicians stateside. But there is a need for consulting radiologists. “Specialists are so used to dealing with very precise, very specific high-quality data that giving them this kind of vagueness—they don’t find that a comfortable space to work in. So we haven’t used a lot of radiologists to date. They would say that our images are not DICOM-compatible or anything close to that,” Kvedar said. “But having a radiologist interpret to their best ability is so much better than having no interpretation.”

Cambodia is the fourth-poorest country in the world and faces a desperate shortage of health care workers, especially in rural areas. “There are so many nice things about working in Southeast Asia,” Kvedar said. “People take great ownership over their care. The average per capita income in these villages is about $40 a year, and they’re willing to put a dollar on the table to pay for their care.”

Kvedar invites radiologists interested in volunteering to e-mail him at [email protected]. “It’s hard to direct people’s attention to this area of the world,” he said. “It’s sad to say, but Cambodia is a forgotten country.”

—C. Vasko

New Conference Focuses On Information Capture

Inefficient information capture can cost hospitals anywhere between $5,000 and $20,000 per clinician per year, according to industry reports, making it the most expensive line item under health information technology (HIT). Organizers of a new conference hope to change all that. The first annual National Conference on Health Information Capture takes place September 18–20, 2006, in Las Vegas.

Available to physicians, nurses, and other attendees are educational sessions conveying strategies for increased accuracy, efficiency, and speed in information capture. Topics include medical transcription; handwriting and speech recognition; document imaging; and emerging technologies, such as digital paper, tablet PCs, and smart phone entry. Also, an exhibit hall will feature vendors displaying their health care documentation solutions.

“Not being able to capture critical patient information electronically in the most cost-effective, user-friendly, legal, and time-saving means possible is the biggest obstacle standing in the way of widespread EMR adoption,” said C. Peter Waegemann, CEO of Medical Records Institute Inc, Boston, which has organized the conference.

Visit for more information.